Rehab Journal Review

Archives of PMR, November 2014

2000 One from our own stable. VS Ramachandran (have you watched his TED Talk?) was among the first to study the scientific basis of mirror therapy. And this is what my colleagues have found in a pilot randomized study-  “Mirror therapy enhances motor performance in the paretic upper limb after stroke“. The editors have chosen this among their featured articles and freed it from behind the pay-wall! The next step? We need to do an adequately powered RCT, perhaps with occupational outcomes as measures of effectiveness. And, we’d be hearing lots more about the first author, Sam. #yhihf

2120 Osseointegrated prosthesis is the artificial leg that is fixed to the bone of the amputated limb. Despite its seemingly obvious advantages, this observational study from Sweden does report a few cons, including persistent phantom pain. Is this study design appropriate to know if this method of prosthesis fitting is better than traditional sockets? I don’t think so.

2167 Is anterior AFO useful in stroke patients walking? This Taiwanese paper goes all out to say yes. Isn’t the glaring hole in the PICO of this study obvious?

Spinal Cord, November 2014

809 Platelet RIch Plasma application for stage 4 pressure ulcers– this Indian study finds its place in the Nature-published Spinal Cord journal despite its methodological limitations. Lets wait for a good RCT.

NEJM, November 20, 2014

Finally, gene therapy as a technique delivers. Not just theoretical empty promises but sustained, significant, appreciable clinical benefits to persons with a disease that has no cure otherwise. This Phase 1 clinical trial, for a change (much welcome), is a non-commercial hemophilia treatment trial, with no dubious drug industry influence!!!

P: Persons with Severe Hemophilia B

I: single IV injection of viral vector mediated gene therapy

C: none (phase 1 study)

O: >90% reduction in bleeding episodes and factor requirement, as a result of factor levels improving from ‘severe’ to ‘moderate’ ranges. Effects maintained  upto 3 years, no major side-effects, observations ongoing. Very promising!

Ethical question: though only preliminary, with such possibly robust benefits, is it OK to go ahead with a placebo-controlled phase 2 trial to confirm efficacy?

Practice tidbits

• Do costlier catheters mean better health outcomes in short-term catheterized individuals in hospitals? “No”, says this Cochrane revietew (Sep 2014) that evaluated silver alloy-coated catheters and antibiotic impregnated catheters.

• Is routine vitamin-D screening in asymptomatic adults recommended? “No” says this new US recommendation published in Annals of Internal Medicine, 25 November 2014.

• Should you be pragmatic and choose worldly-wise career options, or pursue your dreams come-what-may? The later perhaps. This list of Top-10 regrets by those about to die makes thought-provoking reading. Especially for those at career cross-roads as I’m in.

• Should you start using Twitter? “Yes” pleads this write up ‘Why every young physician should have a professional Twitter account‘

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Liked on twitter: “#WeCanLandOnACometButWeCant get all scientists to report and interpret bloody p values properly”

“Every step into the unknown is a risk” #Interstellar